# Skeletal system

<mark style="color:$danger;">**This Editorial Guide is used for Education Purposes Only. It is used in the Authoring Courses and Certifications. It is based on the January 2026 Editorial Guide.**</mark>

Since the skeletal system includes bones and cartilage, it is possible to have a procedure on the skeletal system, i.e. on cartilage, that is not a procedure on bone.

* For example,
  * 77825002 |Division of cartilage of wrist (procedure)| is a procedure on the skeletal system (procedure)

{% hint style="info" %}
**Skeletal system subdivision**

SNOMED CT considers the *skeletal system subdivision* part of the entire bone (system). This may change if there are procedures on cartilaginous skeleton that involve skeletal system subdivisions.
{% endhint %}

### Osteotomy <a href="#osteotomy" id="osteotomy"></a>

O*steotomy* is defined as *cutting into or through a bone*; there are 3 meanings in SNOMED CT:

1. Cutting into a bone, regardless of whether the bone is divided (incision, general meaning). Model using Method, Incision - action (qualifier value), and Procedure site - Direct (attribute), bone structure (or subtypes).
   1. For example,
      1. 118483001 |Incision of rib (procedure)|
2. Cutting through a bone and dividing it (division by cutting). Model using Method, Division - action (qualifier value), and Procedure site - Direct (attribute), bone structure (or subtypes).
   1. For example,
      1. 447867002 |Division of ulna (procedure)|
3. Cutting into a bone without cutting through it and therefore without dividing it (incision without division).
   1. This is unnecessary; procedures that do not explicitly involve division are modeled simply as *Incision*.

### Reduction and fixation of fractures <a href="#reduction-and-fixation-of-fractures" id="reduction-and-fixation-of-fractures"></a>

*Reduction and fixation* has two actions by two different means; open reduction of a fracture and insertion of an orthopedic fixation device. This provides an opportunity for general concept inclusion axioms (GCIs) in order to fully represent the meanings without heavy postcoordination modeling. *Open reduction of a fracture* necessarily involves open manipulation of the fracture and *internal fixation of a fracture* necessarily involves the insertion of an orthopedic internal fixation device.

* For example,
  * 74011006 |Open reduction of fracture of tibia and fibula with internal fixation (procedure)|

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